Monday, August 27, 2007

Global Prevalence of Diabetes

"I wonder if the billions of Indian, Chinese, Tibetan, etc. vegetarians or vegans (many for religious reasons) are diabetic and obese b/c of their diet. Damn few, I bet."

That made me wonder. Do the Indians and Chinese fare better when it comes to diabetes? It would be telling if they did.

A recent source for the global prevalence of diabetes is the work of Wild et al., that appeared in the journal Diabetes Care in 2004:

Global Prevalence of Diabetes: Estimates for the year 2000 and projections for 2030

At right is a table from the study, "List of countries with the highest numbers of estimated cases of diabetes for 2000 and 2030". It's informative, for the sheer number of people in the world afflicted. But this table provides pure numbers (not percentages) which could appear to over-represent the disease in highly-populated countries like India and China. It's also fair to say that estimates for the number of people with diabetes in developing countries are more difficult to come by, and may therefore, conversely, be under-representative.

Diabetes In India

I decided to focus on one country, India. According to David Mendosa, one of the biggest and best sites devoted to diabetes in India is run by the husband and wife team, Dr. Rao and Dr. Ushabala: Diabetes-India.com

They state:

"Prevalence of diabetes in urban India is 10 per cent." [It's about 7% here in the US.] In a more recent interview by Mendosa, Dr. Rao revealed, "But we have small studies this year [2001] that say that 14 percent of the population of our cities has diabetes."

"Indians tend to be diabetic at a relatively young age of 45 years which is about 10 years earlier than in West."

"The life expectancy in a diabetic is just about 8 years after the onset of the disease, as they succumb to kidney as well as heart disease more often than others."

"Indians eat less, weigh less and work more than Europeans." ... yet they are "more prone for diabetes than Europeans."

I don't know how meat consumption compares in the US and India. I would guess we eat more meat here, since we are wealthier and can afford it. With this scant information, I might conclude that India has a high rate of diabetes, higher than the US in some places, that coincides with a more vegetarian diet. This is only an association, not cause-and-effect. And it's hardly scientific. Also, it may not be an issue of meat-eating vs. vegetarianism at all, but an issue of type of carbohydrate consumed.

A 2003 article in the British Medical Journal reported:

"Although India's cereal production has soared, the cultivation of pulses, fruits, and vegetables has stagnated. Indian nutritionists say the consumption of fruits and vegetables in India is abysmally low - less than 150g a day, against the recommended 400 g."

One last statement, in the form of a piece of advice, from Dr. Rao:

"Many believe that one should not eat sugar in any form, one should restrict the amount of rice in a meal, one should not eat potatoes, so on and on. But all of them are restrictions on carbohydrate foods, which are not at all harmful as compared to fat foods."

What a curious conclusion, given that as the consumption of fat in this country declined (and the consumption of carbohydrates rose), the incidence of diabetes rose.

What's the answer? Eat less fat, and more carbohydrate? Or the other way around? Diabetes is one perplexing disease.